The Edmonton Clinic: Orientation 101
July – August 2012
How Did We Get Here? Why Are We Here?
2
True Story…
A sweet grandmother telephoned St. Joseph 's Hospital.
She timidly asked, "Is it possible to speak to someone
Who can tell me how a patient is doing?"
The operator said, "I'll be glad to help, dear. What's the
name and room number of the patient?"
The grandmother in her weak, tremulous voice said,
"Norma Findlay, Room 302."
The operator replied, "Let me put you on hold while I
check with the nurse's station for that room."
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True Story (con’t)
After a few minutes, the operator returned to the phone
and said, "I have good news. Her nurse just told me that
Norma is doing well. Her blood pressure is fine; her blood
work just came back normal, and The grandmother said,
"Thank you. That's wonderful. I was so worried. God bless
you for the good news."
The operator replied, "You're more than welcome. Is
Norma your daughter?"
The grandmother said, "No, I'm Norma Findlay in Room
302. No one tells me anything."
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VISION
“Edmonton Clinic will be a leading, state-of-the-art
enabler of integrated, patient centered clinic care,
education and research”
(Functional Program 2006)
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Vision 2020 Goals
• Providing
the right service, in the right place and at the right time
• Enhancing access to high quality services in rural areas
• Matching workforce supply to demand for services
• Improving
coordination and delivery of care
• Building a strong foundation for public health
Source: “Vision 2020: The Future of Health Care in Alberta, 2008”
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AHS Ambulatory Care: Past & Future
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Location of Ambulatory Clinics
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Walter Mackenzie Centre
Clinical Sciences Building
Aberhart Centre
College Plaza
Garneau Professional Building
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Trailers (various)
Glenrose Rehabilitation Hospital
Van Vliet Centre
Dentistry/Pharmacy Centre
Ambulatory Current State
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Competing inpatient & academic requirements
Internal department silos; team care increasing
Emphasis on customer service, access
New services & technologies (e.g., eClinician)
Significant process variability
Provincial resources impacted by Alberta economy
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The Real Past….
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AHS Ambulatory Care
• Inpatient philosophy
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Specialty care
Complex patients
Higher resource per case
Privacy
Safety
Family-centered care
Focus on transition of
patients from acute to subacute/secondary facilities
• Ambulatory philosophy
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High volume
Repetitive transactions
Lower resource per case
Customer service &
consumerism
Convenience & accessibility
Coordination of related
services
Flexibility & modularity
Shared support
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Ideal Patient Experience
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Guiding Principles: Ambulatory Care Gold Standards
• I can easily access and schedule my care and navigate through AHS.
• My providers share one source of information about me and coordinate
my plan of care.
• I have choices in my health care and my decisions are respected.
• I know what to expect and have information and assistance as I need it.
• Everyone shares ownership for delivering my Gold Standard experience.
• I feel comfortable and secure in a caring environment.
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Core Operating Principles
• Patients and their families can easily access Care and
navigate through the Alberta Health System.
• Providers share one source of patient information and
coordinate plans of care.
• Patients have choices in their healthcare and their
decisions are respected.
Note: Core Operating Principles have been adapted from Ambulatory Care – Gold Standard Patient Experience (Jan
2007) and based on feedback from the 6 Operational Planning Sub-groups.
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Core Operating Principles
• Patients know what to expect and have information and
assistance as needed.
• Everyone shares ownership of the Ideal Patient Care
Experience.
• Patients are comfortable and feel secure in the patient care
environment.
• A Team Care model will be the standard model for care
within The Clinic.
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Benefits of the Edmonton Clinic
• Integrated Ambulatory Care experience for patients
• Enhanced research opportunities
• Implementation and support for an interprofessional
model of care
• Optimal use of clinic space
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Overall Guardrails
• A “centralized,” common scheduling platform & basic functionality of an
electronic health record (EHR).
• Limited number of providers will be assigned offices in EC based on
clinical need.
• General Clinic hours of operation will be 0800 -1800 Mon. – Fri. with
exceptions as clinically appropriate.
• Clinical exam rooms will be flexibly assigned, not “owned”.
• Clinical programs will have “level” schedules.
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Overall Guardrails
• Programs will share common spaces (e.g., waiting, lounges,
interdisciplinary rooms & conference rooms).
• Standardized approach to assigning resources throughout the
building to ensure minimum service standards are met (e.g., checkin, patient rooming, room turnover).
• Team Care is coordinated appropriately for the needs of the patient.
• Each clinical area will develop an education/learning and clinical
research plan to ensure that adequate space is available to support
these missions.
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Planning and Design Principles
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Patient Centered:
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Implementation of pre-registration processes
Consistent check-in processes across clinics
Booking of follow up appointments
Building design features an on-stage, off-stage concept
Intuitive way finding principles
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Student Centered:
• Interdisciplinary rooms located on each floor, in close
proximity to the clinical areas
• Rooms equipped with Telehealth to support
participative education and learning for both patients
and staff
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Research Focused:
• Research space designed into the building to facilitate
clinical trials and research
• Education and Research Committee in place to review
ways to enhance research activities in the Edmonton
Clinic
• Enhanced research opportunities with the EMR
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Flexibility:
• Exam and procedure rooms designed on a grid to
enable flexible scheduling of rooms between providers
• Standardized room size, layout and furnishings to
accommodate changes in use of the space
• Like clinics located adjacent to each other to promote
sharing of space as well as developing linkages
between programs
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Information Technology
• Wireless IT infrastructure
• eClinician – Scheduling & electronic medical record
(EMR) solution for clinics moving into the Edmonton
Clinic
• Interconnectivity to the University of Alberta for ease of
access for clinicians
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A to Z of Building Facts…
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Areas and Locations of Ambulatory Clinics:
Level 8
– Department of Dentistry
Level 7
– Shelled: Northern Alberta Urology Centre
Level 6
– Shelled
Level 5
– Shelled
Level 4
– Neuroscience & Shelled
Level 3
– Medicine & Transplant
Level 2
– Surgery, Glen Sather Sports Medicine Clinic,
Volunteers
Level 1
– Family Medicine/Seniors’, Knowledge Commons,
Public Learning Resource Centre, Pharmacy
(retail and AHS), Site Administration
Level 0
– DI and Lab/ECG
• Outpatient Volume (2008) = 370,000 visits
• Outpatient Volume = Accommodating 1 million patient visits
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Access to EC
Level 1:
• Northwest corner  Fire
Department & staff with card
access
• Northeast corner  LRT
• Main entrance
• Corridor 1X114
• Parkade
• Southwest  Aberhart
• Southeast corner
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Access to EC (con’t)
Level 2:
• Northeast  pedway
• Parkade
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Access to EC (con’t)
Level 0:
• Northeast  Tunnel
• West side  loading dock
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Amenities: Staff
• Washrooms
• Lockers:
– Staff side of building  northwest corner
– Limited clinics/departments have lockers
– Managers determined assignment
– Staff provide lock
• Staff Meeting rooms:
– Include TV, fridges, microwaves & phone
– No coffee pots or bottle water dispensers
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Amenities: Public
• Vending Machines & water fountains  public elevators
• Public vs. patient washrooms:
– Public in main corridors (north – south)
– Patient within clinic space
– Barrier Free
– Non-Gender specific
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Amenities: Public
• ATM  level 1 & 2 near parkade
• Phones:
• 1 pay phone  level 1 near parkade
• DATS & Taxi 1 each  level 1 near parkade
• Public Resource Learning Centre (Level 1):
– Like a library with computers and printer
– For public & staff
– Open Mon-Fri from 0800 to 1615h
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Amenities: Public
• Prayer and Meditation room:
– Level 2
– Multi-denominational

• Food Market & Coffee Bar  RFP presently
• Locker:
– Limited clinics/departments
• Padlock operated
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Is This a Public or Patient Washroom?
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What Room Do You Think This Is?
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Leadership in Energy and Environmental Design
LEED
EC is being constructed to achieve a silver certification
Third-party certification program and an internationally
accepted benchmark for the design, construction and
operation of high performance green buildings.
Why is this important to AHS?
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Design
• Optimize energy performance
• Water efficient landscaping
•
30% Water use reduction
• Staff and Clients are encouraged to use other means of
traveling to and from the Clinic
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Construction
• Construction waste diverted from
landfills
• Use of building materials from
recycled material
• Over 20% of the materials in the
building are extracted and
manufactured regionally
• Over 50% of the wood products
come from a sustainable source
certified by the FSC
• Low emitting materials used
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Other Features
• Ongoing measurement and verification to monitor utility
usage
• Green housekeeping
•
Green education
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Paging..
• Quiet philosophy
– No overhead paging
– Fire Voice Activation System for
Emergency Preparedness  code red
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Emergency Power
• Limited emergency power due to size of generator
• Building code affected degree of emergency power
• Generator can only have 80% of load
• Life saving measures is NB:
– Fire pumps, fire alarms, smoke evacuation fans
– 2 elevators
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Emergency Power: Specific Examples
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Egress lightening in hallways
 power to offices, meeting/classrooms,
 power to exam rooms
Procedure rooms:
– Procedure light no power
– Lights either side of stretcher have power
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Emergency Power: Specific Examples
•  Medical gases
•  Medical vacuum (suction)
•  power medication fridges, Pyxis medstation,
blood fridges
• Biomedical waste cooler
• Dentistry has unique power
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Emergency Power: IT
•  Laptop works if battery charged
•  Wall clocks battery operated
• UPS for ~ 5 – 15 min:
– Wireless access & Network
– Security Cameras
– VOIP phones
•  PC/Printers
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Quick Facts?
• You need to page a staff member to return to your
clinic. How would you do that?
• Where are the public elevators?
• How can you tell difference from staff vs. patient
washrooms?
• Where is the staff side of the building?
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Parking:
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8 levels with ~ 1200 stalls
10 short term parking stalls at front of EC
Entrance and exit to 115 Street; no access to 83rd Ave
Vestibules/elevators:
– Pay on foot stations
– Wheel chair corals
• Blue help phones near stairwells
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Parking (con’t)
• Level 0:
– Loading dock & mail room
• Level 1:
– Parking Office
– Access to EC
– DATs, Taxis, & ambulances
– Short term & courier
– Reciprocal
– Bike storage
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Parking (con’t)
• Level 2:
– Access to EC
– Barrier free parking
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Parkade
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Room Types
• # of Clinical rooms:
– Consult: 21
Exam: 181
– Procedure: 28
Other types: 251
• # of Non-clinical rooms:
– Communication Centers
– Interdisciplinary, meeting & conference
– Offices (limited)
– Staff meeting
Total number of rooms is 1199
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Security: What is the Philosophy?
Goals:
– Well defined perimeter security
– Controlled access to public areas
– Staff  call for assistance, panic alarms & CCTV
Mid level threat:
– Vehicle theft
– B & E, Assaults
– Workplace violence
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Security: What is in place?
• Landscaping  Intermittent in size & texture
• Signage consistent, uniform & able to be seen from street
• CCTV cameras:
– Entries & exits
– Elevator lobbies
– Public waiting & reception areas
– ATMs & vending machines
– Access to Pharmacy
– At risk hallways/areas
– Some stairwells in the parkade
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Security: What is in place?
• Audio-visual phones in high risk areas (e.g.. Health
Records, Pharmacy)
• Duress alarms:
– Areas of financial transactions (e.g.. Foundation,
Cashiers’, Admitting & Registration)
– High risk areas based on detailed design (e.g..
Interview stations & all Reception Desks)
• Duress alarms & IP cameras Protective Services
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Security: What is in place?
• Financial transactions:
– Security IP camera
– Money intake  floor mounted safe
– Point of Sale  limited areas
– Cash rooms  signage does not indicate purpose
• Convex mirrors:
– 180 degrees dome flush with no arm
– Found in areas hard to see around corners
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Security: Card Readers
Limited Use of Card Readers
- Exterior doors – main level
- Tunnel entrance
- Medication Rooms
- Telehealth Storage
- Clean Supply
- Staff Elevators
- Locker Rooms
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Security: Keying Strategy for Common Rooms
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Interdisciplinary
Oxygen Storage
Staff Meeting
Housekeeping
Wheelchair Storage
Waiting
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Lost and Found: Oops Only Found
• Found:
– Responsible for found items
– Send found items to EC Protective Services
– Transferred to WMC
– Call Protective Services at WMC to determine if a
found item is present
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Wayfinding: AKA Signage
• 3 levels of signage:
– Exterior
– Corridors & main public area
– Inside clinics
• Types of signs:
– Dynamic  electronic signs that may be updated
– Static  never change, frequent sign at WMC
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Wayfinding (con’t)
• Dynamic:
– Monoliths: Level 1 & 2 Only
– Ready boards: outside waiting rooms
• Static signs:
– Frequent signage
– Variety of types, including sizes
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Wayfinding (con’t)
• Each floor has unique colour to assist with wayfinding
• Consider EC like your home…limited signs as need to
invite patients inside
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What Type of Signage is This?
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A to Z of Clinical Facts
• Code Blue
Stretcher Patients
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Emergency Preparedness: Code Blue
• No cardiac arrest teams, except tunnel or MET
• Provide BLS until EMS arrives  they take over
• AEDs (18) throughout EC
– Emergency Carts (11) in limited locations
– Only BLS supplies (e.g.. tape, razor, portable suction)
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Emergency Preparedness: Code Blue
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Emergency Preparedness: Code Blue
• Process Clinic Space With Emergency Cart:
– First Responder:
• Determine unresponsiveness, call “help”, activate
nurse call & start BLS
– Second Responder:
• Call “help” , dial 9-9-1-1, call security @7.8347
• Obtain emergency cart
• Place towel outside door
• Assist with BLS
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Emergency Preparedness: Code Blue
• Process Spaces Without Emergency Cart:
– First Responder:
• Determine unresponsiveness, call “help”, retrieve
closest AED, dial 9-9-1-1 & start BLS
– Second Responder:
• Call “help”, ensure 9-9-1-1 activated, dial 33#
• Obtain emergency cart, if possible
• Assist with BLS
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Emergency Preparedness: Code Blue
• Tunnel:
– Cardiac Arrest Teams respond
– Use blue help phones indicating location
– Paged only in WMC as “Edmonton Clinic Tunnel
Code Blue”
• Parkade:
– Use blue help phones  indicate location
– Control centre  call 9-9-1-1 & inform Protective
Services
– Return to patient & perform BLS
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Stretcher Patients
• EC is like your home
• Stretcher patients not to been seen in front of house to
maintain patient dignity
• Specific entrance: corridor 1X114
– Card access reader from parkade into EC
– AHS Transport Services staff will have access
– Non AHS Transport staff will need to be escorted
• Patient taken directly to clinic room  registered & checked
in
• Remain in room until patient picked up
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Stretcher Patients (con’t)
• Process for Non AHS Transport staff:
– Call ADM reception desk  state clinic & Level
– ADM Receptionist call Medicine Service Worker
– Service worker:
• To corridor 1X114 to provide access
• Escorts Transport staff to service/staff elevators
lobby for appropriate clinic
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Quick Facts?
• Which entrance would a patient in a wheelchair use to
gain entrance to EC?
• What is the turn around time when AHS Transport
Services is contacted for ambulance pick-up?
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Ambulatory Care: Past & Future
• We will “give up” some level of control by adhering to common
guidelines (“The Guardrails”)
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Common scheduling platform (eClinician)
Limited physician offices in The Clinic
Exam rooms are flexibly assigned
Programs will share common spaces
• But we are receiving advantages in return
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Efficiency
Outcomes : Demonstrated performance
Social
Time/convenience
Satisfaction
Economic
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What Does ECS Look Like Inside?
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What Space is This?
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What is This? What Level?
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What is This?
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What is This?
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What is This?
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What is This?
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What is This?
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What Space is This?
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EC - Telephony
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Telephone types:
– VOIP
• daily use
• Located throughout the building
– Analog
• daily use and can be used when the network is down
• Located primarily in staff meeting areas and locker rooms
– Emergency (orange) phones
• Can be used when the PBX is down – i.e. all phones including analog
phones are not working
• Allows for outgoing calls / internal calls only if dialed directly
• Located primarily in Reception areas and some communication centers
– Blue Phones
• Emergency phones outside of the main building
• Located in the parkade and tunnel
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EC - Telephony
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1120e model:
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Analog model:
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1140e model:
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Blue Phone:
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Soiled Utility Sinks
Each soiled utility room has the two sinks above.
Which one is the hand washing sink?
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New Equipment at the EC
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Nurse Call
New kind of nurse call system!
• Push button or pull cord
• All calls configured as
Emergency
• Illuminate flashing red with a
fast ding dong tone
• Clear only at station of origin
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Ceiling lifts
Lifts are installed in 6 different locations
• One in Diagnostic Imaging (patient holding)
• Two in Neurosciences (EMG and procedure room)
• Two in Medicine Clinics (procedure rooms)
• One in Surgery (procedure room)
• Maximum weight capacity 625 lbs.
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Portable Oxygen
Within the Edmonton Clinic,
portable oxygen for patients
will be supplied by
“Grab and Go” cylinders
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Panic Buttons
Located at
• registration desks
• classrooms
Security dispatched
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Macerators
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Pneumatic Tube
A tube system that provides air cushioned
soft delivery of items. Items travel at 20
ft/sec. It will be connected to the Lab and
Pharmacy at the WMC.
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What Else is New at the EC
• Difficult IV Starts
• First Aid
• Linen Room
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Difficult IV Starts
For assistance with
difficult IV starts in the
Edmonton Clinic you
may call
Adult Day Medicine
(ADM)
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First Aid
• In compliance with Occupational Health and Safety
Code (2009)
• Designated room is 2B.153 (surgery procedure room)
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Linen Room
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Extra linen will be stored in room # OP029
Linen room will be open from 0800-1600h
After hours call Security to open linen room
Lab Coat Transfers
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Questions &
Answers
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